الفهرس 
Anatomical, Physiological & pathophysiological considerationsOnly 14 pages are availabe for public view
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Abstract
Head injuries account for 75% of all pediatric hospitalizations for trauma and contribute to nearly 80% of trauma deaths in children. Childhood head injuries are often the result of domestic falls, motor vehicle accidents, and recreational injuries such as sports mishaps. Child abuse remains a significant cause of head injuries in children under 2 years of age.
Traumatic brain injuries can be divided into two major stages: Primary brain injuries that occur at the time of impact include extradural and subdural hematomas, intra-cerebral contusions, and diffuse axonal injuries; Secondary injury occurs any time after the primary event, and potentially preventable causes include systemic hypotension, hypoxemia, hypercapnia, and hyperthermia.
Peri-operative management of head-injured patients focuses on aggressive stabilization of the patient and avoidance of systemic and intracranial insults that cause secondary injury.
The goal of the primary survey of trauma (the initial phase of resuscitation) is to rapidly evaluate and treat any immediate life-threatening injuries. It is performed in a prescribed sequence including evaluation of airway, breathing, circulation, disability, and exposure (ABCDEs).
Care should be taken in patients with suspected cervical spine fracture and a baseline neurologic examination should be performed after initial resuscitation, and should be repeated at frequent intervals because the patient’s condition may change rapidly.
Only by frequent evaluation and assessment can the physician detect and treat the child appropriately prior to decompensation.
The major goals of anesthetic management are to optimize cerebral perfusion and oxygenation, avoid secondary damage, and provide adequate surgical conditions for the neurosurgeons.
Most patients should be transferred to the ICU, the main objectives are to optimize recovery from primary brain injury and prevent secondary injury. This requires provision of optimal systemic support for cerebral energy metabolism and adequate CPP, and normalizing of ICP for the injured brain. To achieve this, multi-modality systemic and cerebral monitoring should be instituted.